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Thursday, 28 November 2013

Pulmonary vascular disease – Pulmonary embolism – The Risk Factors

Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
I. Pulmonary embolism
Pulmonary embolism (PE) is defined as a condition of blockage of blood flow due to a blood clot of either in main artery of the lung or somewhere else in the body. In most cases, it is in the deep veins of the legs or pelvic. The disease is a common and affect as many as 500,000 persons annually in the United States.
B.2. Risk factors
1. Pregnancy
Pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. According to the study by the University of Minnesota Residency Program, physicians should maintain an appropriately high index of suspicion and request diagnostic imaging in a timely manner. Diagnosis of deep venous thrombosis with Doppler ultrasonography of the lower extremity poses no health risk to the fetus, but other radiographic studies pose a low radiation risk to the fetus. Because anticoagulant therapy poses a greater health risk to mother and fetus than does the radiation required for the diagnosis of pulmonary embolism, clinicians should aggressively pursue objective evidence of venous thromboembolism(10)
2. Intracardiac thrombosis
Right intracardiac thrombosis (IT) is a potential cause of pulmonary embolism (PE), according to the study of data Between 1970 and 1982, 23 796 autopsies, representing 84% of all in-hospital deaths in the Malmö city population, were performed, using a standardized procedure by the Uppsala University Hospital(11).
3. Obesity
The number of overweight and obese individuals in the population has increased dramatically in the past few decades, and the rising prevalence of obesity is a major public health concern. The prevalence of pulmonary embolism in hospitalized patients was higher in obese patients than in non-obese patients. Mortality in patients with pulmonary embolism was lower in obese patients than in non-obese patients, with the greatest effects in women, older patients and stable patients(12).
4. Burns
It has been estimated that 26% of Americans are obese. A very small subset of this group can be categorized as morbidly obese, fulfilling the criteria of being 100 pounds, or 100%, over ideal body weight. The clinical records of seven morbidly obese burn patients treated over a 20-year period are reviewed. Particularly notable was a 43% incidence of fatal pulmonary embolism(13).
5. Cancers
Patients with cancer are as increased risk of pulmonary embolism. According to the systematically reviewed Medline, Web of Science, and the Cochrane Library databases and selected 26 studies, by Stony Brook University Medical Center, including 2 randomized controlled trials, and 4 prospective, 18 retrospective cohort, and 2 case-control studies. Overall incidence of PE was 3.6%. Pulmonary embolism abbreviated survival in 2 studies when the diagnosis was synchronous with lung cancer. Venous thromboembolism prophylaxis, treatment, and surveillance are inconsistently reported. Clinical outcome data pertaining to this topic are limited and of overall poor methodologic quality(14).
6. Trauma
Trauma is a leading causes of death and disability in young people. Venous thromboembolism (VTE) is a principal cause of death. Trauma patients are at high risk of deep vein thrombosis (DVT)(15).
7. Heart attack and Heart surgery
Patients with current or previous heat attacked and surgery are associated to the higher risk of pulmonary embolism.
8. Device implanted
There is a report of a case of a 32-year-old woman with a septic pulmonary embolism-related implanted central venous port(16).
9. Childbirth
There is a report of identified 10 specific recurrent errors that account for a disproportionate share of maternal deaths, primarily related to pulmonary embolism, severe preeclampsia, cardiac disease, and postpartum hemorrhage(17).
10. Other risk factors
Body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment) are other risk factors of pulmonary embolism, according to the total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity(18).
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Sources(10) http://www.ncbi.nlm.nih.gov/pubmed/11021260
(11) http://www.ncbi.nlm.nih.gov/pubmed/15695529
(12) http://www.ncbi.nlm.nih.gov/pubmed/22078437
(13) http://www.ncbi.nlm.nih.gov/pubmed/1474621
(14) http://www.ncbi.nlm.nih.gov/pubmed/22626760
(15) http://www.ncbi.nlm.nih.gov/pubmed/23543562
(16) http://www.ncbi.nlm.nih.gov/pubmed/23507605
(17) http://www.ncbi.nlm.nih.gov/pubmed/22270288
(18) http://www.ncbi.nlm.nih.gov/pubmed/20624138